title: A cost-effective sestamibi protocol in the managed health care era.
abstract: BACKGROUND
  In the managed health care era a need exists to lower the cost of diagnostic tests for coronary artery disease. One possible approach is to eliminate the rest study in the conventional stress-rest perfusion imaging protocol with single photon emission computed tomography.
  
  
  OBJECTIVE
  The aim of the study was to determine the frequency with which single stress single photon emission computed tomography acquisition can be used to diagnose disease in normal patients compared with dual stress-rest protocol.
  
  
  METHODS
  Two hundred patients without history of myocardial infarction, coronary revascularization, valvular disease, dilated cardiomyopathy, or left bundle branch block undergoing 1-day (n = 86) or 2-day (n = 114) stress-rest sestamibi imaging were studied. The stress was exercise in 147 patients and pharmacologic in 53 patients.
  
  
  RESULTS
  On the basis of the stress study, 112 patients had normal images, and 88 patients had abnormal images. On the basis of the combined stress-rest images, 131 patients had normal images, and 69 patients had abnormal images (agreement 85%, kappa 0.68 +/- 0.05). Only 6 (5%) of the 112 patients with normal images based on the stress images were considered to have abnormal images by the combined stress and rest images.
  
  
  CONCLUSIONS
  In patients with normal stress images elimination of the rest study rarely alters interpretation. Rest studies are most useful in patients with abnormal or equivocal stress images. Such selective elimination of the rest studies may decrease the cost of nuclear procedures and should be considered in the current managed care health system.
authors.affiliation: Nuclear Medicine Department, Civic Hospital of Brescia, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Milan
authors.forename: R
authors.initials: R
authors.lastname: Giubbini
authors.forename: G
authors.initials: G
authors.lastname: Gioia
authors.forename: A
authors.initials: A
authors.lastname: Terzi
authors.forename: A E
authors.initials: AE
authors.lastname: Iskandrian
mesh_terms: D000328:Adult; D000368:Aged; D003362:Cost-Benefit Analysis; D005080:Exercise Test; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017256:Technetium Tc 99m Sestamibi; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: D017256:Technetium Tc 99m Sestamibi